Guide wire insertion and re-insertion tools and methods of use

ABSTRACT

An insertion tool and method for easily inserting a guide wire into a guide wire lumen of a catheter, particularly a rapid exchange catheter, for use in an endoscope. The insertion tool includes a main body having a main lumen and a funnel-shaped extension having a funnel lumen that merges with the main lumen. The funnel lumen has a first large opening and a second smaller opening aligned with the guide wire lumen of the catheter such that, when the catheter is disposed in the main lumen, the guide wire may be easily inserted into the large opening of the funnel-shaped extension and into the guide wire lumen of the catheter. Also, a re-insertion tool and method for re-inserting a guide wire into a channel of a catheter. The re-insertion tool is particularly useful in combination with an endoscope and an SOE catheter disposed therein.

CROSS REFERENCE TO RELATED APPLICATIONS

This application is a continuation of U.S. patent application Ser. No.09/312,438, filed May 14, 1999, now U.S. Pat. No. 6,606,515, which is acontinuation-in-part of U.S. patent application Ser. No. 09/080,520,filed May 18, 1998, entitled “Guide Wire and Catheter Locking Device andMethod”, now U.S. Pat. No. 6,096,009; which is a continuation-in-part ofU.S. patent application Ser. No. 08/926,200, filed Sep. 9, 1997,entitled “Single Operator Exchange Biliary Catheter”, now U.S. Pat. No.6,007,522; which claims priority to U.S. Provisional Application No.60/025,235, filed Sep. 13, 1996, entiled “Single Operator ExchangeBiliary Catheter”, the entire disclosures of which are hereinincorporated by reference. This application is related to U.S. patentapplication Ser. No. 09/312,340, filed May 14, 1999, entitled “SingleOperator Exchange Biliary Catheter With Common Distal Lumen”, now U.S.Pat. No. 6,346,093, which is herein incorporated by reference.

FIELD OF THE INVENTION

The present invention generally relates to endoscopic devices andmethods of use. Specifically, the present invention relates to cathetersfor use in combination with guide wires and endoscopes.

BACKGROUND OF THE INVENTION

Endoscopic procedures for treating abnormal pathologies within thealimentary canal system and biliary tree (including the biliary,hepatic, and pancreatic ducts) are increasing in number. The endoscopeprovides access to the general area of a desired duct using directvisualization. However, the duct itself must be navigated using acatheter in conjunction with fluoroscopy and guide wires.

Catheters are known for treatment of targeted anatomical regions. Knownmethods and devices for using biliary catheters for accessing thebiliary tree for performing catheter procedures are disclosed in Weaveret al., U.S. Pat. No. 5,397,302 and Karpiel, U.S. Pat. No. 5,320,602,the disclosures of which are herein incorporated by reference. Ingeneral, for treatment of an abnormal pathology within a patient'sbiliary tree, an endoscope is first introduced into the mouth of thepatient. The endoscope includes a proximal end and a distal end, and hasa lumen extending longitudinally between the proximal and distal ends.The endoscope is guided through the patient's alimentary tract or canaluntil an opening at the distal end of the endoscope is proximate thearea to receive treatment. At this point, the endoscope allows othercomponents, such as a catheter, to access the targeted area.

For visualization or treatment within the biliary tree, the distal endof the endoscope is positioned proximate to the papilla of vater leadingto the common bile duct and the pancreatic duct. A catheter is guidedthrough the lumen of the endoscope until a distal tip of the catheteremerges from the opening at the distal end of the endoscope.

The catheter may be used for accessing the biliary tree. The distal endof the catheter is guided through the orifice to the papilla of vater(located between the sphincter of oddi) leading to the common bile ductand the pancreatic duct. A guide wire may be used in conjunction withthe catheter to facilitate accessing a desired location within thebiliary tree. The guide wire is inserted in an opening at a proximal endof the catheter and guided through the catheter until it emerges fromthe distal end of the catheter.

If visualization of the common bile duct is desired, the guide wire isguided into the common bile duct. The catheter is advanced over theguide wire, as previously described, until the distal end of thecatheter is positioned in the common bile duct at the desired location.The catheter is now in position for delivery of contrast media forfluoroscopic visualization of anatomical detail within the common bileduct.

Visualization may reveal selected areas within the common bile duct thatrequire treatment. To treat the selected areas, a different catheter istypically required, necessitating a catheter exchange. A catheterexchange typically involves removing the first catheter from theendoscope over the guide wire, and advancing a second catheter over theguide wire to the desired treatment site. Thus, once the guide wire isin place relative to the targeted area, it is highly desirable tomaintain the position of the guide wire during subsequent catheterprocedures, including during a catheter exchange procedure. If the guidewire moves during such a procedure, the guide wire may have to bere-directed through the body ducts to the target site, which is often adifficult, time consuming, and tedious task.

In addition to performing a catheter exchange procedure, it may also bedesirable to perform a guide wire exchange procedure. This may bedesirable when, for example, a first guide wire is too large to fitthrough a desired body duct, or otherwise lacks the desiredcharacteristics. Under these circumstances, a physician may leave thecatheter in place, withdraw the first guide wire from the catheter, andinsert a second guide wire through the catheter to the desired site.During this procedure, the catheter guides the guide wire to the desiredsite. Thus, once the catheter is positioned at a target site, it ishighly desirable to maintain the position of the catheter during a guidewire exchange procedure so that the second guide wire may be guideddirectly to the desired site in a minimum amount of time.

To maintain the position of a guide wire and/or catheter, a physiciantypically must grasp the proximal end of the guide wire and/or catheterwith one hand, and perform the corresponding exchange with the other.This is difficult and often results in the movement of the guide wireand/or catheter. Therefore, it would be desirable to provide a lockingdevice whereby the physician can secure the position of the guide wireand/or catheter during an exchange procedure, thereby freeing both handsto perform other tasks.

It would also be desirable to have a tool for inserting a guide wireinto a catheter. Inserting a guide wire into the guide wire lumen of arapid exchange catheter, whether in preparing the catheter and guidewire for insertion into the endoscope or performing a lo guide wireexchange procedure, is often difficult due to the relatively small sizeof the guide wire entry slot or port. Specifically, the guide wire entryslot or port may be difficult to locate on the catheter shaft and, evenafter the guide wire slot or port has been located, inserting the guidewire into the guide wire lumen may be as difficult as threading aneedle. Accordingly, it would be desirable to have a tool and method forassisting in the insertion of a guide wire into a catheter, particularlya rapid exchange catheter.

SUMMARY OF THE INVENTION

The present invention provides an insertion tool and method for easilyinserting a guide wire into a catheter, particularly a rapid exchangecatheter, for use in an endoscope. An insertion tool in accordance withan embodiment of the present invention includes a main body having alumen sized to accommodate the catheter and a funnel-shaped extensionhaving a funnel-shaped lumen that merges with the main lumen. Thefunnel-shaped lumen has a large first opening and a smaller secondopening aligned with the guide wire lumen of the catheter such that,when the catheter is disposed in the main lumen, the guide wire may beeasily inserted into the large opening of the funnel-shaped lumen andinto the guide wire lumen of the catheter.

The catheter, as in a rapid exchange catheter, may include alongitudinal slot that provides access to the guide wire lumen, in whichcase the insertion tool may include a corresponding tongue or keydisposed in the main lumen. Alternatively, the insertion tool mayinclude a non-round (e.g., flat) surface that engages a similar surfaceon the catheter. The tongue or engaging surface is aligned with thefunnel-shaped extension and the slot of the catheter to thereby maintainalignment between the funnel-shaped lumen and the slot. The insertiontool may also include a longitudinal slot in the funnel and/or main bodythat is aligned with the longitudinal slot of the catheter to allowremoval of the guide wire from the insertion tool while the guide wireremains disposed in the guide wire lumen of the catheter.

A method of using an insertion tool in accordance with an embodiment ofthe present invention includes the steps of placing the insertion toolon the catheter such that the catheter extends through the main lumenand inserting the guide wire through the funnel-shaped extension of theinsertion tool and into the guide wire lumen of the catheter. Theinsertion tool may be slidable or stationary on the catheter. If theinsertion tool is slidable on the catheter, the insertion tool may beadvanced along the catheter to insert a section of thereof securely intothe lumen of the endoscope, preferably prior to inserting the guidewire. The section may be inserted a sufficient distance to open thevalve in the lumen of the endoscope to permit unhindered longitudinalmovement of the catheter through the valve. After the guide wire hasbeen inserted into the guide wire lumen of the catheter, the guide wiremay be removed from the insertion tool through a slot in thefunnel-shaped extension and/or main body while the guide wire remains inplace within the catheter. The insertion tool may then be removed fromthe lumen of the endoscope by sliding the tool proximally along thecatheter.

The present invention also provides a re-insertion tool and method forre-inserting a guide wire into a channel of a catheter. The re-insertiontool is particularly useful in combination with an endoscope and a SOEcatheter disposed therein. Because the endoscope may be too small toaccommodate the guide wire and the catheter side-by-side, it isdesirable to reintroduce the guide wire into the channel of the catheterproximal of the port of the endoscope, before advancing or retractingthe catheter and/or guide wire. Specifically, with the distal portion ofthe guide wire disposed in the channel/guide wire lumen of the catheterdistal of the port of the endoscope, and the proximal portion of theguide wire disposed adjacent to the catheter proximal of the port, there-insertion tool may be used to re-introduce the guide wire into thechannel of the catheter proximal of the port. The re-insertion toolthereby facilitates easy retraction and advancement of the catheterand/or guide wire relative to the endoscope. Preferably, the reinsertiontool has an outside diameter greater than the inside diameter of thelumen of the endoscope. Also preferably, the lumen of the reinsertiontool has an inside diameter sized to accommodate the catheter, but lessthan the inside diameter of the lumen of the endoscope. The reinsertiontool may further include a keel sized to fit in the channel of thecatheter.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a perspective view of a catheter in accordance with thepresent invention, having a U-shaped channel and guide wire lumen fordirecting a guide wire along its shaft and for facilitating rapidcatheter exchange;

FIG. 1A is a cross-sectional view of the catheter of FIG. 1 taken alongthe line A—A;

FIG. 1B is a cross-sectional view of the catheter with guide wire ofFIG. 1 taken along the line B—B;

FIG. 1C is an enlarged fragmentary perspective view of the catheter ofFIG. 1 at circle C;

FIGS. 1D and 1E are cross-sectional views of the fragment illustrated inFIG. 1C;

FIGS. 2A-2D are cross-sectional views of the catheter of FIG. 1 locatedwithin increasingly larger endoscope channels;

FIG. 3 is a perspective view of an endoscope exchange sheath assembly,without slit, suitable for receiving the catheter of FIG. 1;

FIG. 3A is an enlarged fragmentary perspective view of the encircledsheath section of FIG. 3 at 3A;

FIG. 4 is a perspective view of an alternative embodiment sheathassembly having a slit sheath and two-piece hub, shown in an unlockedposition;

FIG. 4A is a perspective view of the two-piece hub of FIG. 4 in a lockedposition;

FIG. 4B is an enlarged fragmentary perspective view of the encircledsheath section of FIG. 4 at 4B, having a slit;

FIG. 4C is an enlarged fragmentary perspective view of a sheath section,having an overlap, an alternate embodiment of the sheath in FIG. 4B;

FIG. 5 is a perspective view of the catheter of FIG. 1 inserted throughthe endoscope sheath assembly of FIG. 4;

FIG. 6 is a perspective view of an endoscope sheath section containing acatheter having a U-shaped channel containing a guide wire;

FIG. 7 is a partial perspective view of a guide wire within the catheterof FIG. 1 inserted through the endoscope sheath assembly of FIG. 4,which is in turn within an endoscope;

FIG. 7A is a perspective view of the sheath assembly of FIG. 7, havingthe catheter removed;

FIG. 8 is a partial perspective view of an alternative embodiment of asheath assembly, including an introducer;

FIG. 8A is an enlarged perspective view of the introducer of FIG. 8;

FIG. 9A is an enlarged, cross-sectional view of an alternativeembodiment of the introducer of FIG. 8;

FIG. 9B is an enlarged, cross-sectional view of another alternativeembodiment of the introducer of FIG. 8;

FIG. 9C is an enlarged, cross-sectional view of another alternativeembodiment of the introducer of FIG. 8;

FIG. 9D is an enlarged, cross-sectional view of another alternativeembodiment of the introducer of FIG. 8;

FIG. 9E is an enlarged, perspective view of another alternativeembodiment of the introducer of FIG. 8;

FIG. 9F is an enlarged, cross-sectional view of another alternativeembodiment of the introducer of FIG. 8;

FIG. 10 is a perspective view of an illustrative locking device;

FIG. 11 is a partial side view of an illustrative locking devicepositioned on an endoscope having an angled side port;

FIG. 12 is a partial side view detailing the illustrative locking deviceof FIG. 11;

FIG. 13 is a perspective view of another illustrative locking device;

FIG. 14 is a perspective view of yet another illustrative lockingdevice;

FIG. 15 is a partial side view of another illustrative locking devicepositioned on an endoscope having an angled side port;

FIG. 16 is an enlarged fragmentary perspective view of an insertion toolin accordance with a first embodiment of the present invention;

FIGS. 17A and 17B are cross-sectional views taken along line 17—17 inFIG. 16;

FIGS. 18A, 18B, and 18C are enlarged views of an insertion tool inaccordance with a second embodiment of the present invention;

FIG. 19 is a perspective view of a re-insertion tool in accordance witha first embodiment of the present invention;

FIGS. 20A-20F are isometric, top, left side, night side, rear and frontviews, respectively, of the re-insertion tool illustrated in FIG. 19;

FIG. 20G is a cross-sectional view taken along line 20G—20G in FIG. 20F;

FIG. 21 is a perspective view of a re-insertion tool in accordance witha second embodiment of the present invention; and

FIGS. 22A-22C are top, rear and side views, respectively, of there-insertion tool illustrated in FIG. 21.

DETAILED DESCRIPTION OF THE INVENTION

The following detailed description should be read with reference to thedrawings in which similar elements in different drawings are numberedthe same. The drawings, which are not necessarily to scale, depictselected preferred embodiments and are not intended to limit the scopeor spirit of the invention.

FIG. 1 shows a perspective view of a catheter assembly 30 in accordancewith the present invention. Catheter assembly 30 is used in catheterprocedures for accessing targeted anatomical regions through thealimentary canal. The present invention incorporates features whichallow rapid exchange of a catheter by a single operator. The catheter ofthe present invention allows shorter length guide wires to be used,resulting in procedures which require less medical personnel, are lesstime consuming, and less costly. Additionally, the present invention isadaptable to most catheter devices used for catheter procedures withinthe alimentary canal.

Catheter assembly 30 includes a catheter hub assembly 32 and a catheter34, having a guide wire 36 passing through a portion thereof. Catheter34 includes a shaft 38, which in general terms has a proximal end 40, aU-channel 42, a distal tip region 44, a distal end 46 and various lumensdescribed in greater detail below. Catheter hub assembly 32 is operablyconnected to proximal end 40 of shaft 38. Catheter hub assembly 32 ispreferably configured to couple to ancillary devices allowing access toa lumen within shaft 38.

Shaft 38 is a generally tubular shaped member having a generally uniformouter shape at proximal end 40. Shaft 38 may be sized for slidablepassage through the lumen of an endoscope (not shown). Shaft 38 ispreferably formed in an extrusion process. Shaft 38 may be formed of anextruded polymeric material. In one embodiment, the preferred polymericmaterial is polytetrafluoroethylene, polyether block amide, nylon or acombination or blend of these. Catheters which are contemplated include,but are not limited to, cannulas, sphincterotomes, cytology devices, anddevices for stone retrieval and stent placement.

In a preferred embodiment, shaft 38 further includes a distal taper 48which tapers to distal tip region 44. Additionally, tip region 44 mayinclude high contrast, color coded distal markers 50. Finally, distalend 46 may be radiopaque for fluoroscopic visualization of distal tipregion 44 during a catheter procedure.

U-channel 42 of shaft 38 extends between a first, proximal channel end52 and a second, distal channel end 54. U-channel 42 serves to contain,but not necessarily constrain, guide wire 36, between channel proximalend 52 and channel distal end 54. The term “U-channel” refers to achannel shape that allows radial removal of guide wire 36 from thechannel 42, and need not be strictly in the shape of the letter U.Channel 42 in the preferred embodiment is sufficiently large to allowunhindered radial guide wire 36 movement out of channel 42. Further, thechannel walls and radial opening are substantially equal to or slightlylarger than the diameter of a guide wire lumen, described in greaterdetail below. Although it is recognized that proximal channel end 52 maybe located at any location distal of proximal end 40 of shaft 38,channel distal end 54 is preferably located between 10 and 40 cm fromdistal end 46 of catheter shaft 38.

Finally, as shown in FIG. 1A, which is a cross-sectional view of shaft38 taken along line A—A at a location proximal of channel proximal end52, shaft 38 includes ancillary lumen 56, ancillary lumen 58 and guidewire lumen 60.

Ancillary lumen 56 and ancillary lumen 58 extend longitudinally betweenproximal end 40 and distal end 46 of shaft 38. Ancillary lumen 56 andancillary lumen 58 may be injection lumens, allowing for high contrastmedia flow capability for bubble-free opacification and for excellentvisualization of a desired anatomical region. Additionally oralternatively, ancillary lumen 56 and/or ancillary lumen 58 may be usedfor or as part of other ancillary devices, such as a cutting wire lumenor a retrieval balloon lumen.

Guide wire lumen 60 extends longitudinally between proximal end 40 anddistal end 46 of shaft 38 in the preferred embodiment. Further, guidewire lumen 60 is sized to receive guide wire 36. Guide wire lumen 60 maybe a tubular member which is extruded integral catheter shaft 38, oralternatively, guide wire lumen 60 may be a separate tubular memberwhich is coupled to catheter shaft 38. Although in one preferredembodiment the guide wire lumen 60 is a tubular member which is locatedproximate distal end 46 of catheter shaft 38, it is recognized thatguide wire lumen 60 may be formed anywhere along shaft 38, may be anextension of shaft 38 coupled to distal end 46, or guide wire lumen 60may run the entire length of shaft 38.

Referring to FIG. 1B, a cross-sectional view of shaft 38 taken alongline B—B of FIG. 1 is shown. Guide wire 36 may access guide wire lumen60 at a point proximal channel distal end 54. Guide wire 36 extendswithin channel 42 to channel distal end 54, continuing within guide wirelumen 60 through distal tip region 44, and exiting through an opening indistal end 46.

Referring to FIG. 1C, a section of catheter shaft 38 having U-channel 42is shown. The embodiment shown also includes ancillary lumens 56 and 58.Sections of shaft 38 proximate the channel proximal end 52 and distalchannel distal end 54 contain guide wire lumen 60 in communication withU-channel 42. In one embodiment, U-channel 42 has an interior,closed-side geometry, substantially the same as the geometry of guidewire lumen 60. Further, U-channel 42 walls are spaced further than adiameter of guide wire 36 such that guide wire 36 moves freely into andout of U-channel 42.

Catheter shaft 38 can be configured such that U-channel 42 is definedseparately from guide wire lumen 60. With this approach, guide wirelumen 60 is divided into two sections; a first section extending betweenproximal end 40 of shaft 38 and channel proximal end 52; and a secondportion extending between channel distal end 54 and distal end 46 ofshaft 38. Alternatively, the shaft can be configured to define guidewire lumen 60 as extending longitudinally between proximal end 40 anddistal end 46 of shaft 38. In the alternative embodiment; betweenchannel proximal end 52 and channel distal end 54, guide wire lumen 60is integral with U-channel 42. In other words, guide wire lumen 60defines a portion of U-channel 42 such that spacing between outer wallsof U-channel 42 is equal to a diameter of guide wire lumen 60.Regardless of how guide wire lumen 60 and U-channel 42 are defined,U-channel 42 provides for access to guide wire lumen 60 at channeldistal end 54. In this regard, channel distal end 54 can be enlarged tomore easily direct guide wire 36 into guide wire lumen 60.

Guide wire lumen 60 and U-channel 42 allow rapid exchange of catheterassembly 30 when an alternative catheter is necessary during a certainmedical procedure. Shorter length guide wires may be used since guidewire 36 does not pass through shaft proximal end 40 and hub assembly 32,but rather exits the catheter shaft 38 at U-channel 42 locatedsubstantially distal from proximal end 40. The unique catheterconstruction in accordance with the present invention will reducecatheter therapeutic and diagnostic procedure time since catheter deviceexchanges may be performed relatively more easily and quickly by asingle operator. Additional personnel and time associated withmaintaining the placement of a conventional (approximately 400 cm) guidewire within the targeted anatomical region is eliminated, reducing theoverall costs of the procedure.

Referring now to FIGS. 1D and 1E, which are cross-sectional views of theshaft 38 fragment illustrated in FIG. 1C. Specifically, FIG. 1D is aprecise cross-sectional view of the shaft 38 fragment illustrated inFIG. 1C, and FIG. 1E is an alternative cross-sectional view of the shaft38 fragment illustrated in FIG. 1C. As described previously and now withreference to FIG. 1D, catheter shaft 38 includes a U-channel 42, a firstancillary lumen 56 and a second ancillary lumen 58. In this embodiment,U-channel 42 collectively defines a guide wire lumen and a slotproviding access to the guide wire lumen. Similarly, in the embodimentillustrated in FIG. 1E, C-channel 43 collectively defines a guide wirelumen and a narrower slot for accessing the guide wire lumen. Thenarrower slot of C-channel 43 may have a dimension of approximately0.018±0.002 inches and is designed to better contain the guide wiretherein. C-channel 43 may eliminate the need for a separate exchangesheath when using endoscopes with larger lumens.

Referring to FIGS. 2A through 2D, cross-sectional views of endoscopeworking channels 70-76 containing a catheter according to FIG. 1 areshown. In the examples illustrated in FIGS. 2A through 2D, workingchannel inside diameters 70, 72, 74, and 76 are 2.8, 3.2, 3.8, and 4.2mm, respectively. FIG. 2A illustrates catheter shaft 38 having ancillarylumens 54 and 56, U-channel 42, and guide wire 36 within U-channel 42.Further, shaft 38 is shown within a first size endoscope working channel70. In FIG. 2A, guide wire 36 is effectively radially constrained bysmall sized working channel 70 that closely surrounds U-channel 42.

FIG. 2B illustrates catheter containment within a second size workingchannel 72, slightly larger than the working channel 70 of FIG. 2A. InFIG. 2B, guide wire 36 is able to move out of U-channel 42 to a positiondenoted with dashed lines at 80. FIG. 2C shows shaft 38 contained withina third, even larger sized working channel 74. Guide wire 36 is able tomove completely out of U-channel 42 to position 82 shown with dashedlines. Finally, FIG. 2D demonstrates catheter shaft 38 within a fourthsize working channel 76. In this even larger working channel, guide wire36 lies within an even larger cross-sectional area, and is able to moveto a position shown in FIG. 2D with dashed lines at 84.

As shown with the larger endoscope working channels (FIGS. 2C and 2D),the potential for guide wire 36 to slip out of U-channel 42 creates apotential for the guide wire 36 to become pinched and restrict desiredmovements of both guide wire 36 and catheter shaft 38. For this reason,when larger endoscope working channels are used, an exchange sheathhaving a sufficiently small inner diameter so as to constrain guide wiremovement to within the catheter U-channel 42 is employed with thepreferred embodiment. Generally speaking, an endoscope exchange sheathin accordance with the preferred embodiment allows for use of a radiallyaccessible guide wire, which is longitudinally aligned with thecatheter, while presenting a circular profile to an endoscope andmitigating guide wire pinching problems between the catheter and theendoscope working channel wall.

Referring to FIG. 3, an endoscope exchange sheath assembly 100 havingsheath hub assembly 102 and a sheath 104 is shown. The sheath 104includes a lumen 106 and a distal end 108. FIG. 3A shows a section ofsheath 104, having lumen 106 for receiving a catheter. Basically, withreference to FIG. 1, catheter 34 is fed through lumen 106 of sheath 104such that sheath 104 encompasses guide wire 36 within U-channel 42.Sheath 104 is adapted to be disposed within an endoscope workingchannel, thereby providing a smaller diameter channel than that of thesurrounding endoscope working channel constraining the guide wire 34(FIG. 1) to the U-channel 50 (FIG. 1), and mitigating the potentialproblems shown in FIGS. 2C and 2D.

Referring to FIG. 4, an alternate endoscope exchange sheath assembly 110is shown. Sheath assembly 110 includes a two-piece hub assembly 112 anda sheath 114 defining lumen 116 and having slit 118 extendinglongitudinally over its length, terminating at distal end 120. Slit 118in sheath 114 is shown in more detail in FIG. 4B.

Referring again to FIG. 4, two-piece hub assembly 112 has a proximal hubportion 122 and a distal hub portion 124, having a proximal slit 126 anda distal slit 128, respectively. Sheath slit 118 is in communicationwith hub slits 126 and 128, allowing a guide wire (not shown) to beradially slid into or out of sheath assembly 110. Proximal hub portion122 is shown unlocked (position “A”) in FIG. 4, aligning hub proximalslit 126 with hub distal slit 128 and sheath slit 118, providing acontinuous slit for guide wire radial movement into and out of thesheath assembly 110. Proximal hub portion 122 is shown locked, inposition “B”, in FIG. 4A, whereby proximal hub slit 126 is rotated withrespect to distal hub slit 128, preventing a guide wire (not shown)within hub assembly 112 from being moved radially out of hub assembly112. Proximal hub portion 122 is set to position B (FIG. 4A) when radialguide wire movement is not desired.

FIG. 4C illustrates a portion of an alternate embodiment sheath 130having a lumen 132, a sheath wall opening 134 and sheath wall overlap136. A guide wire (not shown) is able to be slid out of lumen 132 ofsheath 130 by maneuvering the guide wire into sheath wall opening 134and through overlap 136.

Referring to FIG. 5, catheter assembly 30 depicted in FIG. 1 is showninserted within endoscope exchange sheath assembly 10 depicted in FIG.4. More particularly, catheter 34 is inserted through slitted sheathassembly 110, extending distally out sheath distal end 120. Guide wire36 (shown partially in FIG. 5) is positioned within U-channel 42 ofcatheter 34, along guide wire lumen 60 (FIG. 1B), and extends from shaftdistal end 46. Further, guide wire 36 is engaged by hub assembly 112.More particularly, guide wire 36 passes within and is engaged byproximal slit 126 and distal slit 128 of hub assembly 112. Sheathproximal hub portion 122, having proximal slit 126, is shown in lockedposition relative to sheath distal hub portion 124, having distal slit128. Thus, in the locked position, hub assembly 112 of sheath assembly110 prevents radial withdrawal of guide wire 36, otherwise inserted inU-channel 42 of catheter 34, from distal the channel proximal end 52.

Referring to FIG. 6, a section of FIG. 5 is shown in detail, havingendoscope sheath 114 containing catheter shaft 38, which furthermaintains guide wire 36 within U-channel 42. As shown, sheath 114 isable to constrain movement of guide wire 36 from U-channel 42 whensheath 114 is within a larger endoscope working channel, for example asillustrated in FIGS. 2C and 2D. Importantly, the sheath 114 embodimentillustrated in FIG. 6 includes longitudinal slit 118, allowing guidewire 36 to be peeled from catheter shaft 38 and endoscope sheath 114. Inother words, as previously described, U-channel 42 is sized larger thanguide wire 36 such that guide wire 36 can displace radially fromU-channel 42. Sheath 114 prevents undesired displacement of guide wire36 from U-channel 42 under normal operating conditions. However, ifadequate radial force is placed on guide wire 36 by an operator, guidewire 36 will separate sheath 114 along slit 118 such that guide wire 36is displaced from sheath 114 and U-channel 42.

Referring to FIG. 7, guide wire 36 is shown inserted within catheterassembly 30 of FIG. 1, which is inserted through endoscope sheathassembly 110 of FIG. 4, which is in turn within an endoscope 150. Sheathassembly 110 includes sheath 114 that has slit 118 and two-piece hubassembly 112, shown at a locked position “B” (also in FIG. 4A). Havinghub assembly 112 locked prevents guide wire 36 from moving radially outof sheath 114 through slit 118. Guide wire 36 can be restrained fromlongitudinal movement by applying finger pressure on the guide wire 36against hub assembly 112.

Referring to FIG. 7A, endoscope 150 and sheath assembly 110 of FIG. 7are shown without the catheter assembly 30 inserted, as after catheterwithdrawal. Sheath hub assembly 112 is shown in unlocked position at “A”(also in FIG. 4). Having hub assembly 112 unlocked allows radialmovement of guide wire 36 out of sheath 114 through slit 118, but suchmovement may be restrained by trapping guide wire 36 against the outsideof sheath 114 using one finger, providing ease of guide wire 36 controlduring catheter exchanges.

In one possible endoscopic procedure, an endoscope 150, as illustratedin FIG. 7, is first introduced into the mouth of a patient and is guidedthrough the patient's alimentary canal. Specifically, endoscope 150 isguided down the esophagus, through the stomach, past the pyloricsphincter of the stomach and into the duodenum. Endoscope 150 has alumen extending longitudinally between its proximal end and the distalend.

Endoscope 150 is guided through the alimentary canal until a distal end(not shown) of endoscope 150 is proximate the target area within theanatomy to receive treatment. In an endoscopic biliary procedure,endoscope 150 is guided into the duodenum until the opening at thedistal end of the endoscope 150 is proximate the papilla of vater. Thepapilla of vater is located between the sphincter of oddi, which leadsto the common bile duct, hepatic, and pancreatic ducts. The proximal end(shown in FIGS. 7 and 7A) of endoscope 150 extends and remains outsidethe mouth of the patient.

With endoscope 150 properly positioned within the patient, catheterassembly 30 is prepared for insertion into the endoscope. First, guidewire 36 is fed into the guide wire lumen 60 (FIGS. 1A-1C) of shaft 38.More particularly, a distal end of guide wire 36 is placed withinU-channel 42, distal the channel proximal end 52. The guide wire 36 isthen fed to channel distal end 54 (FIG. 1) into guide wire lumen 60.Finally, guide wire 36 is fed through shaft 38 to distal tip region 40(FIG. 1). In one method, catheter 32 is then inserted directly intoendoscope 150 working channel. This method may be practiced with anendoscope having a sufficiently small working channel inside diameter,as illustrated in FIG. 2A, to constrain guide wire 36 movement without asheath.

However, in a preferred method (with reference to FIG. 7), catheterassembly 30, threaded with guide wire 36, is inserted into sheathassembly 110, thereby constraining guide wire 36 from slipping radiallyout of U-channel 42. More particularly, catheter 34 is inserted intoendoscope 150 working channel, but leaving channel proximal end 52proximate sheath hub assembly 112, and leaving a portion of guide wire36 extending from the channel proximal end 52 as well. Notably, sheathhub assembly 112 includes hub slits 126 and 128 which receive a portionof guide wire 36. Thus, in the preferred embodiment, hub assembly 112 islocked, preventing unwanted radial guide wire 36 movement. In apreferred method, the loading of guide wire 34 into catheter shaft 38and catheter shaft 38 into sheath assembly 110 is done prior toinserting endoscope 150 into a patient (not shown).

Endoscope sheath 114, containing catheter shaft 38, is inserted intoendoscope 150 working channel. Endoscope sheath 114 serves to constrainradial guide wire 36 movement over the approximate length of U-channel42. Catheter shaft 38 and sheath 114 are inserted together intoendoscope 150 until both are near a distal end (not shown) of endoscope150. Catheter shaft 38 and sheath 114 may be, either or both, advanceduntil exiting the distal end of endoscope 150.

In one method, guide wire 36 is advanced until guide wire 36 distal tipis positioned within the target area in the biliary tree (including thecommon bile, hepatic or pancreatic ducts). For example, the distal tipof guide wire 36 may be guided through the orifice leading to thepapilla of vater for access to the biliary tree. Catheter shaft 38 maythen be advanced over guide wire 36, tracking catheter assembly 30,until catheter distal tip region 40 (FIG. 1) exits distal end ofendoscope 150 and is positioned within the desired duct. In anothermethod, guide wire 36 and catheter assembly 30 are advanced togetheruntil catheter distal end 42 (FIG. 1) is positioned at the target area.It is also recognized that the catheter could be first advanced to nearthe target area, followed by inserting the guide wire when needed toadvance the catheter further.

Once guide wire 36 is in position at the target area, catheterprocedures, including injecting contrast media, such as radiopaque dye,through ancillary lumens 56 or 58 (FIGS. 1A-1C) into the common bileduct for visualization of the duct, can be performed. After the desiredcatheter procedure has been completed, catheter assembly 30 can beexchanged or removed from endoscope 150, leaving guide wire 36 inposition for other catheter procedures. Catheter assembly 30 and sheathassembly 110 may also be removed together.

One method of withdrawing catheter 34 from endoscope 150 is possibleusing either a slitted/overlapped endoscope sheath 114 as depicted inFIGS. 4 through 4C, or a sheath 104 without a slit as depicted in FIGS.3 through 3A. Using this method, best visualized with reference to FIG.7, guide wire 36 is held to prevent longitudinal movement while catheter34 is retracted within endoscope sheath 114 (or 104). Catheter 34retraction leaving the guide wire 36 in position within the patient isenabled by U-channel 42 being radially open to guide wire 36 removal incatheter shaft 36. Once catheter retraction has brought channel distalend 54 (FIG. 1) to a point proximate sheath hub assembly 112, only arelatively short portion of guide wire 36, from channel distal end 54 todistal end 46 (FIG. 1) of catheter shaft 38, remains within catheter 34.A single operator can remove this remaining portion of guide wire 36from catheter 34 by first slightly retracting catheter assembly 30(while still holding guide wire 34 in place) out of sheath assembly 110(or 100), such that a portion of guide wire 36 is accessible distal ofcatheter distal end 46. In other words, a small portion of guide wire 36is accessible between distal end 46 of catheter 34 and distal hubportion 124 of sheath assembly 110. The accessible portion of guide wire36 is then held by the operator, while withdrawing the remaining portionof catheter 34 completely over guide wire 36. In an alternative method,the distal end of the endoscope can include an elevator which could beutilized to lock the distal end of the guide wire in position while thecatheter is removed.

Exchange of endoscope sheath assembly 110 may be desired, as when astent (not shown) is to be advanced over guide wire 36, and the stenthas a larger outside diameter than can be accommodated by the sheath114. One method of exchanging an endoscope sheath assembly 110 may beused where sheath 114 is slitted as in FIG. 4B, or overlapped, as insheath 130 in FIG. 4C. Referring to FIG. 7A, two-piece hub assembly 112is turned to the unlocked position “A” (also shown in FIG. 4). Guidewire 36 is pulled radially away from sheath hub assembly 112 and throughslit 118 in sheath 114. Guide wire 36 is then held, preferably againstsome portion of endoscope 150, to prevent guide wire 36 from beingdislodged from position within the patient. Sheath 114 is retracted fromendoscope 150, guide wire 36 being “peeled” away from sheath 114. Sheathretraction is continued until sheath 114 is completely outside ofendoscope 150 and over guide wire 36. At this point, guide wire 36 iswithin endoscope 150 working channel, and stents, catheters, andendoscope sheaths may be advanced over guide wire 36.

Another method of exchanging both endoscope sheath assembly 110 andcatheter assembly 30 may be used where the sheath 114 is slitted as inFIG. 4B, or overlapped, as in sheath 130 in FIG. 4C. Referring to FIGS.7 and 7A, two-piece hub assembly 112 is turned to the unlocked position“A” (FIG. 7A). Guide wire 36 is pulled radially away from U-channel 42of catheter 34, from hub assembly 112 and through slit 118 in sheath114. Guide wire 36 is then held, preferably against some portion ofendoscope 150, to prevent guide wire 36 from being dislodged fromposition within the patient. Sheath 114 and catheter 34 are retractedfrom endoscope 150, with guide wire 36 being “peeled” away from sheath114. Sheath assembly 110 and catheter assembly 30 retraction arecontinued until sheath 114 and catheter 34 are completely outside ofendoscope 150 and over guide wire 36. At this point, guide wire 36remains in a position within endoscope 150 and patient. A singleoperator can access a small portion of guide wire 36 between distal end46 (FIG. 1) of catheter 34 to hold guide wire 36 in place while catheterassembly 30 is completely removed or disengaged from guide wire 36.

While sheath assembly 110 has been described as including a two-piecehub assembly 112 in conjunction with sheath 114, other assemblies may beused. For example, referring to FIG. 8, an alternate sheath assembly 160is shown. Sheath assembly 160 includes an introducer 162, an attachmentmeans 164 and a sheath 166. Similar to previous embodiments, sheath 166defines a lumen (not shown) and includes a slit 168 extendinglongitudinally over its length, terminating at a distal end 170. Sheath166 is generally identical to sheath 104 and sheath 114 previouslydescribed. Introducer 162 is attached to sheath 166 by attachment means164 such that lumen (not shown) of sheath 166 is in fluid communicationwith an interior portion of introducer 162. In one preferred embodiment,attachment means 164 is a flexible membrane which seals sheath 166 tointroducer 162. Alternatively, other forms of attachment, such as anadhesive or frictional engagement between introducer 162 and sheath 166may also be useful.

Referring to FIG. 8A, introducer 162 is shown in greater detail.Introducer 162 is a funnel-shaped device including a horn 172 and a neck174. In one preferred embodiment, horn 172 and neck 174 are integrallyformed as a singular body.

Horn 172 is preferably a conically-shaped body having an outer wall 176.Outer wall 176 defines an interior space and includes a guidewire-receiving notch 180 formed near proximal end 182 of horn 172. Guidewire-receiving notch 180 is preferably J-shaped and includes an entryend 184 and a locking end 186. As shown in FIG. 8A, entry end 184 isopen at proximal end 182 of horn 172. Conversely, locking end 186 isclosed.

Neck 174 is preferably tubular in shape, and includes a passage 188.Passage 188 is configured to be in fluid communication with interiorspace of horn 172. In the preferred embodiment, horn 172 and neck 174are formed of a plastic material. Alternatively, any other semi-rigid orrigid, surgically-safe material may be used.

Referring to FIGS. 1, 8 and 8A, during use, catheter assembly 34(FIG. 1) is inserted within sheath assembly 160. More particularly,distal end 46 (FIG. 1) of catheter shaft 38 (FIG. 1), including guidewire 36 (FIG. 1) is placed within horn 172 of introducer 162. Theconical shape of horn 172 assists in directing distal end 46 of cathetershaft 38, including guide wire 36, into passage 188 of neck 174.Catheter shaft 38 continues forward within lumen (not shown) of sheath166 until distal end 46 of catheter shaft 38 extends from distal end 170of sheath 166.

Once properly inserted within sheath assembly 160, a proximal end ofguide wire 36 (FIG. 1) is maintained within guide wire-receiving notch180. More particularly, a portion of guide wire 36 is forced by anoperator through entry end 184 of guide wire-receiving notch 180 andforced within locking end 186 thereof. In this regard, locking end 186preferably has a diameter slightly smaller than that of guide wire 36.Thus, locking end 186 frictionally maintains guide wire 36. Conversely,guide wire 36 can easily be released from guide wire-receiving notch 180by sliding guide wire 36 from locking end 186 and out of entry end 184.Thus, sheath assembly 160 functions in a manner highly similar to sheathassembly 100 and sheath assembly 110 previously described.

Referring to FIG. 9A, an alternative embodiment of an introducer 190 isshown. Introducer 190 includes a horn 192, a neck 194 and a valve 196.Similar to previous embodiment, horn 192 and neck 194 are preferablyintegrally formed as a singular body. Horn 192 includes an outer wall197 which defines a guide wire-receiving notch 198 and valve-receivingslots 200. Valve 196 includes a valve body 202 sized to fit within outerwall 197 of horn 192. Further, valve 196 includes ribs 204 extendingfrom valve body 202. Ribs 204 are preferably sized to mate withinvalve-receiving slots 200 of horn 192. Thus, valve 196 is maintainedwithin horn 192 via interaction of ribs 204 with valve-receiving slots200. In this regard, valve-receiving slots 200 are preferably positionedalong horn 192 proximal neck 194. Valve 196 is preferably made of arubber-type material.

During use, introducer 190 functions in a manner highly similar tointroducer 162 (FIGS. 8 and 8A) previously described. Additionally,however, valve 196 forms a seal about catheter shaft 38 (FIG. 1). Thus,upon insertion into a human body, valve 196 prevents bodily fluids, suchas bile, from backing up through the sheath assembly. Additionally,valve 196 can provide for aspiration, if desired.

Referring to FIG. 9B, an alternative embodiment of an introducer 206 isshown. Introducer 206 is highly similar to introducer 190 (FIG. 9A)previously described. In this regard, introducer 206 includes a horn208, a neck 210 and a valve 212. Horn 208 is preferably integrallyformed with neck 210 and includes an outer wall 214 defining a guidewire-receiving notch 216 and valve-receiving slots 218. Similar to valve196 (FIG. 9A), valve 212 includes a valve body 220 and ribs 222. Ribs222 are sized to mate within valve-receiving slots 218 of horn 208. Inthis regard, valve-receiving slots 218 are positioned proximate aproximal end 224 of horn 208. Introducer 206, including valve 212,functions in a manner highly similar to introducer 190 (FIG. 9A) aspreviously described.

It is recognized that the fluid blocking function provided by valve 212can be achieved with other designs. For example, referring to FIG. 9C,an alternative embodiment of an introducer 226 is shown. Introducer 226includes a horn 228, a neck 230 and an O-ring 232. Horn 228 and neck 230are preferably formed as an integral body. Horn 228 preferably includesa guide wire-receiving notch (not shown) similar to that previouslydescribed and an interior slot 234. Interior slot 234 is preferablypositioned proximate neck 230 and is sized to maintain O-ring 232.Alternatively, interior slot 234 can be formed in neck 230.

O-ring 232 is preferably made of a rubber-type material. Further, O-ring232 has an inner diameter slightly smaller than that of horn 228 andneck 230. Thus, during use, O-ring 232 forms a seal about catheter shaft38 (FIG. 1), blocking passage of bodily fluids, such as bile, into horn228.

Referring to FIG. 9D, another alternative embodiment of an introducer236 is shown. Introducer 236 is similar to a touhey-borst system andincludes an upper horn section 238, a lower horn section 240 and agrommet 242. Upper horn section 238 includes an outer wall 244 defininga proximal end 246, a grommet-receiving flange 248 and a distal end 250.Proximal end 246 of horn section 238 preferably includes a guidewire-receiving notch (not shown) similar to that previously described.Distal end 250 is threaded and includes a passage 252 sized to receive aportion of lower horn section 240.

Lower horn section 240 includes a body 254 defining a proximal end 256,an intermediate portion 258 and a distal end 260. An interior passage266 is configured to communicate with passage 252 and extends fromproximal end 256 to distal end 260. Finally, proximal end 256 includes athreaded slot 262 sized to threadably receive distal end 250 of upperhorn section 238.

Grommet 242 is preferably made of a rubber-type material and is sized tonest within grommet-receiving flange 248 of upper horn section 238 whileabutting proximal end 256 of lower horn section 240.

Introducer 236 is assembled by placing grommet 242 withingrommet-receiving flange 248 of upper horn section 238. Distal end 250of upper horn section 238 is then threadably secured to proximal end 258of lower horn section 240. As upper horn section 238 is threadablysecured to lower horn section 240, proximal end 256 of lower hornsection 240 compresses grommet 242 within grommet-receiving flange 248of upper horn section 238. During use, introducer 236 functions in amanner highly similar to that previously described. In this regard,grommet 242 forms a seal about catheter shaft 38 (FIG. 1). Further,aspiration can be achieved, if desired, by loosening lower horn section240 relative to upper horn section 238.

Referring to FIG. 9E, yet another alternative embodiment of anintroducer 266 is shown. Introducer 266 includes a horn 268, a neck 270and a valve 272. Preferably, horn 268, neck 270 and valve 272 areintegrally formed as a singular body. In this regard, valve 272 isformed while molding horn 268 and neck 270 by imparting a controlledflash at distal end 274 of neck 270.

Introducer 266 performs in a manner highly similar to that previouslydescribed. Thus, valve 272 forms a seal about catheter shaft 38 (FIG.1), thereby preventing back flow of bodily fluids, such as bile, intohorn 268.

Referring to FIG. 9F, another alternative embodiment of an introducer276 is shown. Introducer 276 includes a horn 278, a neck 280 and a valve282. Horn 278 and neck 280 are preferably integrally formed as asingular body. In this regard, horn 278 and neck 280 are defined by anouter wall 284. Outer wall 284 forms a guide wire-receiving notch 286and an exterior slot 288. Guide wire-receiving notch 286 is similar tothat previously described. Exterior slot 288 is positioned along neck280 and is sized to maintain a portion of valve 282. Alternatively,exterior slot 288 can be positioned along horn 278.

Valve 282 is preferably a rubber-type sock defined by an upper rib 290,a side wall 292 and a shoulder 294. Upper rib 290 is preferably sized tomount within exterior slot 288 of neck 280. Side wall 292 is preferablyflexible so as to stretch along neck 280. Finally, shoulder 294 ispreferably configured to abut a distal end 298 of neck 280. With thisconfiguration, valve 282 is placed over distal end 298 of neck 280 suchthat shoulder 294 contacts distal end 298. Due to the preferred flexiblecharacteristic of valve 282, side wall 292 is stretched until upper rib290 nests within exterior slot 288 of neck 280.

During use, the catheter shaft 38 (FIG. 1) is placed through introducer276 such that shoulder 294 of valve 282 forms a seal about cathetershaft 38. Thus, valve 282 prevents undesired back flow of bodily fluids,such as bile.

FIG. 10 is a perspective view of an illustrative locking device for usewith an endoscope having a side instrument port. The illustrativelocking device is generally shown at 320 and includes a body member 322.At one end, the body member 322 includes one or more hook members 324for attaching the locking device to a shaft of an endoscope or the like(see FIG. 11). At the other end, the body member 322 includes a securingmechanism for securing a guide wire or catheter to the locking device.

The hook members 324 may be provided in pairs, as shown in FIG. 10, oroffset from one another, as shown in FIG. 13. In either case, the hookmembers 324 are adapted to clip and secure the locking device to theshaft of an endoscope or the like.

The securing mechanism preferably includes one or more openings providedin the body member 322. In the embodiment shown, the body member 322includes a guide wire opening 326 and a catheter opening 332. The guidewire opening 326 is similar to the guide wire-receiving notch 180 ofFIG. 8A. The guide wire opening 326 is preferably J-shaped, andpreferably includes an entry slot 328 and a locking slot 330. Thecatheter opening 332 is boot shaped, and also preferably includes anentry slot 334 and a locking slot 336.

The entry slot 328 of the guide wire opening 326 is dimensioned to belarger than the diameter of a guide wire. The locking slot 330 of theguide wire opening 326 is dimensioned to be somewhat smaller than thediameter of a guide wire. Accordingly, a guide wire can be secured tothe body member 322 by inserting a portion of the guide wire through theentry slot 328 of the guide wire opening 326 and into the locking slot330. The locking slot 330 frictionally secures the guide wire relativeto the body member 322.

Likewise, the entry slot 334 of the catheter opening 332 is dimensionedto be larger than the diameter of a catheter. The locking slot 336 ofthe catheter opening 332 is dimensioned to be somewhat smaller than thediameter of a catheter. Accordingly, a catheter can be secured to thebody member 322 by inserting a portion of the catheter through the entryend 334 of the catheter opening 332 and into the locking slot 336. Thelocking slot 336 frictionally secures the catheter relative to the bodymember 322.

FIG. 11 is a partial side view of an illustrative locking devicepositioned on an endoscope with an angled side port extending therefrom.The endoscope is generally shown at 350, and includes a main shaft 352with a lumen extending therethrough. A side port 356 extends laterallyaway from the main shaft 352 at an angle. The side port 356 providesaccess to the lumen of the main shaft 352. Accordingly, a guide wireand/or catheter may access the lumen of the main shaft 352 via the sideport 356.

The side port 356 preferably includes a side port opening 354 which islaterally spaced from the main shaft 352 due to the angular displacementbetween the main shaft 352 and the side port 356. The side port opening354 is in fluid communication with the lumen of the main shaft 352 via aconnection tube 355. The connection tube 355 intersects a side wall ofthe main shaft 352 at an angle, as shown.

A locking device having a body member 360 is shown clipped onto the mainshaft 352 of the endoscope. The body member 360 includes a number ofhook members 358 for attaching the locking device to the main shaft 352.Two hook members are visible in FIG. 11. The hook members 358 aresimilar to the hook members 324 described above with respect to FIG. 10.

The body member 360 extends away from the hook members 358 and generallyparallel to the side port 356. In FIG. 11, the body member is obscuredby the main shaft 352 and side port 356. The body member 360 extendsupward past the side port opening 354, wherein a securing mechanism isprovided. Preferably, the securing mechanism is a J-shaped guide wireopening 362.

In use, a guide wire is advanced into the body via the endoscope. Duringthe advancement of the guide wire, the proximal end thereof may be movedto a first position 364, which is in the entry slot of the guide wireopening 362. Once the guide wire is in a desired position within thebody, the guide wire may be moved to a second position 366, which is inthe locking slot of the guide wire opening 362. The locking slot of theguide wire opening 362 frictionally secures the guide wire relative tothe body member 360.

FIG. 12 is a partial side view detailing the illustrative locking deviceof FIG. 11, with an additional oversized catheter opening shown. Theside port of the endoscope is shown at 356, and the body member of thelocking device is shown at 360. Positioned proximate the side portopening 354 is a guide wire opening 362 and an oversized catheteropening 370. Like above, the guide wire opening is J-shaped and includesan entry slot and a locking slot. Thus, the guide wire may be moved tothe first position 364, which is in the entry slot of the guide wireopening 362. Once the guide wire is in a desired position within thebody, the guide wire may be moved to the second position 366, which isin the locking slot of the guide wire opening 362. The locking slot ofthe guide wire opening 362 frictionally secures the guide wire relativeto the body member 360.

The oversized catheter opening 370 is sized to restrict lateral movementof the catheter 372 but not longitudinal movement of the catheter 372.Providing a guide wire opening that can secure the guide wire relativeto the body member, and an oversized catheter opening for onlyrestricting lateral movement of the catheter 372 may be particularlyuseful in performing a catheter exchange procedure. For example, duringa catheter exchange procedure, the guide wire opening may maintain theposition of the guide wire. The oversized catheter opening 370 mayseparate the catheter from the guide wire, as the catheter is withdrawn.The first and second catheters should be single-operator exchange typecatheters to provide access to the guide wire during the exchange.

FIG. 13 is a perspective view of another illustrative locking device.The embodiment shown in FIG. 13 is similar to the embodiment shown inFIG. 10, but the hook members are laterally offset rather than aligned.For example, hook member 380 is laterally offset from hook member 382 bya distance “D”. This configuration is another example of an attachmentmechanism for attaching the body member to a catheter shaft.

FIG. 14 is a perspective view of yet another illustrative lockingdevice. The locking device is generally shown at 400, and includes abody member 401 having an attachment mechanism 402 at one end and asecuring mechanism 404 at the other. The attachment mechanism 402includes a first hook member 406 and a second hook member 408. The firsthook member 406 and the second hook member 408 are adapted to extendaround a substantial portion of the shaft of an endoscope or the like.Thus, the first hook member 406 and the second hook member 408 may clipthe body member 401 to the desired shaft.

The securing mechanism 404 includes a J-shaped guide wire opening 410and a flap-type catheter opening 412. The J-shaped guide wire opening410 operates similar to that described above. The flap-type catheteropening 412 has a flap 414 formed by cutting the catheter opening 412from the body member 401. The flap 414 is preferably curved to form achannel 416, wherein the end portion 418 of the channel 416 loops backto near the surface of the body member 401. In this configuration, acatheter or guide wire may be selectively provided in the channel 416,which may bend the flap away from the body member 401. Accordingly, theflap 412 may provide force between the guide wire or catheter and thebody member 401 to effectively secure the guide wire or catheter to thebody member 401.

FIG. 15 is a partial side view of yet another illustrative lockingdevice 500. The locking device 500 is positioned between the side port504 and the main shaft 506 of the endoscope 502. The locking deviceincludes a body member 510 that is attached to the main shaft 506 usinga strap 512. Preferably, the strap 512 extends around the entirecircumference of the main shaft 506. Further, the body member 510 mayinclude a guide wire opening 514 and one or more catheter openings 516,as shown.

Refer now to FIG. 16, which is an enlarged fragmentary perspective viewof insertion tool 600 in accordance with an embodiment of the presentinvention. For purposes of clarity, only the shaft 38 of the catheter 30has been illustrated. Similarly, only the side port 504 and the mainshaft 506 of the endoscope 502/150 have been shown (in phantom). Exceptas described herein with specific reference to insertion tool 600,catheter 30 and endoscope 502/150 are the same as described previously.In addition, although not shown, it is to be understood that theinsertion tool 600 and the catheter 30 are designed to be used inconjunction with a guide wire 36 as described previously.

As used herein, reference numerals 42 and 43 alternatively refer toU-channel 42 and C-channel 43, both of which include a slot and guidewire lumen therein. In some instances, reference numerals 42 and 43 mayrefer to the slot or guide wire lumen individually.

Insertion tool 600 includes a main body 602 and a funnel-shapedextension 604. The funnel-shaped extension 604 is connected to anddisposed adjacent to the main body 602. The main body 602 includes amain lumen 606 extending therethrough. Main lumen 606 is sized toaccommodate a shaft 38 of a catheter 30. Preferably, the insertion tool600 is fixed or stationary at the proximal end of the catheter 30, butmay also be slidably disposed thereon. For purposes of illustrationonly, the insertion tool 600 is shown in FIG. 16 as being slidable onthe catheter 30.

Funnel-shaped extension 604 includes a funnel lumen 610 having aproximal opening and a distal opening. The proximal opening of thefunnel lumen 610 is significantly larger than the guide wire 36 designedfor use in the catheter 30 such that the guide wire 36 may be easilyinserted into the funnel lumen 610. The distal opening of the funnellumen 610 is positioned and sized to communicate with the guide wirelumen 42/43 of the catheter 30 such that when the catheter 30 isdisposed in the main lumen 606 of the main body 602, the guide wire maybe easily inserted into the proximal opening of the funnel lumen 610 andinto the guide wire lumen 42/43 of the catheter 30.

The distal portion of the main body 602 and the distal portion of thefunnel-shaped extension 604 merge together to define a merged section605 that has an exterior surface that is sized to fit within the lumenof the side port 504. A valve (not visible) is typically disposed in thelumen of the side port 504. The merged section 605 has sufficient lengthto engage and cross the valve disposed in the lumen of the side port504. If the insertion tool 600 is slidably disposed on the catheter 30,unhindered longitudinal movement of the catheter 30 is permitted throughthe valve when the merged section 605 extends across the valve tomaintain it in the open position. In addition, if a sheath is used,merged section 605 prevents the valve from damaging the thin-walledportion of the sheath.

The main lumen 606 and the funnel lumen 610 also merge together into amerged lumen (not visible) in the merged section 605. The distal openingof the funnel lumen 610 adjacent the merged lumen is aligned with theguide wire lumen 42/43 and is similarly dimensioned such that the guidewire passing through the merged lumen smoothly enters the guide wirelumen 42/43.

Main body 602 includes a proximal ridge 603 that provides a grippingsurface for the user to slide the insertion tool 600 along the shaft 38of the catheter 30 or to otherwise manipulate the insertion tool 600.

As illustrated in FIG. 17A, a first embodiment of the main body 602further includes a tongue or key 608 protruding from the interior wallof the main body 602 into the main lumen 606. The tongue or key 608extends along at least a portion of the length of the main body 602preferably from the proximal ridge portion 603 to a point proximal ofthe distal merged section 605. The tongue 608 is aligned with the slot42/43 and is sized to slidingly fit within the slot 42/43. With thisarrangement, the tongue 608 maintains proper rotational alignmentbetween the insertion tool 600 and the catheter 30. Specifically, thetongue 608 maintains alignment between the distal opening of the funnellumen 610 and the guide wire lumen 42/43 of the catheter 30 such thatthe guide wire is automatically aligned with the guide wire lumen 42/43upon insertion into the proximal opening of the funnel lumen 610.

As illustrated in FIG. 17B, a second embodiment of the main body 602further includes a non-round engaging surface 614 extending along theinterior wall of the main body 602 into the main lumen 606. Thenon-round engaging surface 614 extends along at least a portion of thelength of the main body 602, preferably from the proximal ridge portion603 to a point proximal of the distal merged section 605. The non-roundengaging surface 614 is aligned with a similarly shaped surface 616extending along the side of the catheter 30. Both the engaging surface614 of the insertion tool 600 and the engaging surface 616 of thecatheter 30 are non-round (e.g., flat) to inhibit the rotation of thecatheter 30 relative to the insertion tool 600. Thus, the engagingsurfaces 614 and 616 maintain alignment between the distal opening ofthe funnel lumen 610 and the guide wire lumen 42/43 of the catheter 30such that the guide wire is automatically aligned with the guide wirelumen 42/43 upon insertion into the proximal opening of the funnel lumen610. Those skilled in the art will recognize that other non-roundengaging surfaces 614, 616 may be utilized to prevent relative rotationbetween the catheter 30 and the insertion tool 600.

In preferred embodiments, funnel-shaped extension 604 also includes aslot or groove 612 providing access to the funnel lumen 610. The slot612 extends along the length of the funnel-shaped extension 604 and thedistal merged section 605. The slot 612 is sized to allow passage of aconventional guide wire 36 therethrough. The slot 612 permits theinsertion tool 600 to be slid proximally along the shaft 38 of thecatheter 30 without changing the position of the guide wire 36.

The insertion tool 600 may be made using conventional techniques such asinjection molding and may be formed of any suitable medical gradepolymer such as PP, ABS, or the like. The overall length of insertiontool 600 is approximately 1.50 inches, wherein the proximal portion ofthe main body 602 is approximately 0.50 inches in length, thefunnel-shaped extension 604 is approximately 0.75 inches in length, andthe distal merged section 605 is approximately 0.25 inches in length.

The inside diameter of the main body 602 is sized to accommodatecatheter 30 and, therefore, may have an inside diameter of approximately0.100 inches and an outside diameter of approximately 0.175 inches.Tongue 608 may have a width of approximately 0.0250 inches and a heightof approximately 0.040 inches to correspond to the size and shape of thechannel 42/43.

The funnel-shaped extension 604 may have a proximal outside profile ofapproximately 0.40 inches and a distal outside profile of approximately0.185 inches providing a smooth transition to the distal merged section605.

Merged distal section 605 may have an outside diameter of approximately0.175 inches to snugly fit inside the lumen of the side port 504 and alength of approximately 0.250 inches to engage and cross the valve (notshown) in the side port 504.

The proximal opening of the funnel lumen 610 is significantly largerthan the guide wire 36 to permit easy insertion of the guide wire 36therein. The proximal opening of the funnel lumen 610 may have virtuallyany cross-sectional geometry that is significantly larger than the guidewire 36. For example, the proximal opening of the funnel lumen 610 maybe a polygon having an average height of 0.20 inches and an averagewidth of 0.20 inches.

In use, the insertion tool 600 may be placed on the catheter 30 suchthat the shaft 38 extends through the main lumen 606 of the main body602. As mentioned previously, preferably the insertion tool 600 is fixedat the proximal end of the catheter 30, but may also be slidablydisposed thereon. With the shaft 38 of the catheter 30 extending throughthe main lumen 606 and the tongue 608 extending into the slot 42/43 orthe non-round surfaces 614, 616 engaging each other, the funnel lumen610 is aligned with the guide wire lumen 42/43 of the catheter 30. Theguide wire 36 may then be inserted into the proximal opening of thefunnel lumen 610, through the distal opening of the, funnel lumen 610,through the merged lumen of the distal merged section 605, and into theguide wire lumen 42/43 of the catheter 30.

If the insertion tool 600 is slidably disposed on the catheter 30, priorto inserting the guide wire, the insertion tool 600 may be advancedalong the shaft 38 of the catheter 30 until the merged section 605passes into the lumen of the side port 504 and across the valve disposedtherein. When the merged section 605 is inserted into the lumen of theside port 504 a sufficient distance to open the valve disposed therein,the catheter 30 may be longitudinally moved without interference fromthe valve.

In addition, if the insertion tool 600 is slidably disposed on thecatheter 30, after the guide wire 36 has been inserted into the guidewire lumen 42/43 of the catheter 30, the insertion tool 600 may be slidproximally along the shaft 38 while permitting the guide wire 36 to exitthe funnel lumen 610 through the slot 612. In this manner, the guidewire 36 remains disposed in the guide wire lumen 42/43 of the catheter30 while the insertion tool 600 is removed from the side port 504. Thispermits free manipulation of the catheter 30 and the guide wire 36relative to the endoscope 502/150.

The above-described method of inserting the guide wire 36 into the guidewire lumen 42/43 of the catheter 30 utilizing the insertion tool 600 maybe performed alone or in conjunction with other procedures describedherein. For example, the insertion tool 600 may be used in proceduresutilizing a sheath, lock mechanism, etc., as described herein.

Refer now to FIGS. 18A, 18B, and 18C, which illustrate enlarged views ofan insertion tool 700 in accordance with an alternative embodiment ofthe present invention. FIG. 18A is a side view, FIG. 18B is an end viewand FIG. 18C is a top view of insertion tool 700. Except as describedherein, insertion tool 700 is the same in form and function as insertiontool 600 described with reference to FIGS. 16-17. A notable differenceis that the insertion tool 700 is preferably movable on the catheter 30,but may also be fixed thereon.

Insertion tool 700 includes a main body portion 702 and a funnel-shapedextension 704. The main body 702 and the funnel-shaped extension 704include a main lumen 706 extending therethrough. Main lumen 706 is sizedto accommodate a shaft 38 of a catheter 30 (not shown). Preferably, theinsertion tool 700 is slidably disposed on the catheter 30, but may alsobe fixed or stationary at the proximal end thereof.

Funnel-shaped extension 704 also includes a funnel lumen 710 having atop opening 714 tapering to a bottom opening 716 which provides accessto the main lumen 706. The top opening 714 of the funnel lumen 710 issignificantly larger than the guide wire 36 (not shown) designed for usein the catheter 30 such that the guide wire 36 may be easily insertedinto the funnel lumen 710. The bottom opening 716 of the funnel lumen710 is positioned and sized to communicate with the guide wire lumen42/43 of the catheter 30 such that when the catheter 30 is disposed inthe main lumen 706, the guide wire 36 may be easily inserted into thetop opening 714 of the funnel lumen 710 and into the guide wire lumen42/43 of the catheter 30.

The main body 702 has sufficient length to engage and cross the valvedisposed in the lumen of the side port of the endoscope 502/150 (notshown). The main body 702, when inserted into the side port of theendoscope 502/150, extends across the valve such that the valve ismaintained in the open position. If the insertion tool 700 is slidablydisposed on the catheter 30, unhindered longitudinal movement of thecatheter 30 is permitted through the valve when the main body 702extends across the valve to maintain it in the open position. Inaddition, if a sheath is used, the main body 702 prevents the valve fromdamaging the thin-walled portion of the sheath.

As best seen in FIG. 18B, the funnel-shaped portion 704 further includesa tongue or key 708 protruding from the interior wall defining the mainlumen 706. The tongue or key 708 extends along at least a portion of thelength of the funnel shaped extension 704, and preferably along thelength of the bridge portion 720 as best seen in FIG. 18C. The tongue orkey 708 is sized to snugly fit within the slot 42/43 of the catheter 30and is aligned with the slot 42/43 when the insertion tool 700 isdisposed on the catheter 30.

With this arrangement, the tongue or key 708 maintains proper rotationalalignment between the insertion tool 700 and the catheter 30.Specifically, the tongue or key 708 maintains alignment between thebottom opening 716 of the funnel lumen 710 and the guide wire lumen42/43 of the catheter 30 such that the guide wire 36 is automaticallyaligned with the guide wire lumen 42/43 upon insertion into the topopening 714 of the funnel lumen 710. Similar to the tongue or key 608discussed with referenced to FIG. 17B, the tongue or key 708 may bereplaced by a non-round surface inside the main lumen 706 which engagesa similarly sized and shaped non-round surface on the catheter shaft 38.

In preferred embodiments, the main body 702 also includes a slot orgroove 712 providing access to the main lumen 706. The slot 712 extendsalong the length of the main body 702 and is preferably continuous withthe bottom opening 716 of the funnel lumen 710. The slot 712 is sized toallow passage of a conventional guide wire 36 therethrough. The slot 712permits the insertion tool 700 to be slid proximally along the shaft 38of the catheter 30 while maintaining position of the guide wire 36.

The insertion tool 700 may be used substantially the same as insertiontool 600, except that the guide wire 36 is inserted into the funnellumen 710 by way of the top opening 714. All other aspects of the use ofinsertion tool 700 are substantially similar to the use of insertiontool 600.

Insertion tool 700 may be made using conventional techniques such asinjection molding and may be formed of any medical grade polymer such asPP, ABS, or the like. The overall length of insertion tool 700 isapproximately 1.50 inches, wherein the funnel-shaped extension 704 isapproximately 0.625 inches in length, and the main body portion 702 isapproximately 0.875 inches in length.

The inside diameter of the main body 702 is sized to accommodate aconventional catheter 30 and, therefore, may have an inside diameter ofapproximately 0.100 to 0.120 inches and an outside diameter ofapproximately 0.262 inches tapering to 0.142 inches. Tongue or key 708may have a width of approximately 0.020 inches and a height ofapproximately 0.03 inches to correspond to the size and shape of thechannel 42/43. The bridge portion 720 may have a length of approximately0.220 inches. The slot or groove 712 may have a width of approximately0.060 inches. The top opening 714 of the funnel-shaped extension 704 mayhave a width of approximately 0.280 inches and the bottom opening 716may have a width of approximately 0.060 inches corresponding to thewidth of the slot 712.

The funnel-shaped extension 704 may have a height of approximately 0.444inches and a width of approximately 0.343 inches. The proximal angledsurface of the funnel-shaped extension 704 may be formed at an angle of45 degrees from vertical. The distal angled surface of the funnel-shapedextension 704 may be formed at an angle of 17.5 degrees from horizontal.The inside surfaces defining the funnel lumen 710 may be formed at anangle of approximately 30 degrees from vertical.

Refer now to FIGS. 19 and 20A, which illustrate a re-insertion tool 800in accordance with a first embodiment of the present invention. Forpurposes of clarity, only the shaft 38 of the catheter 30 has beenillustrated. Although not illustrated, the re-insertion tool 800 isdesigned for use in combination with a endoscope 502/150 having a sideport 506 and a main port 504, as shown in FIG. 16. The re-insertion tool800 is illustrated from a distal viewpoint with the endoscope in thedirection indicated by arrow 802. Except as described herein withspecific reference to re-insertion tool 800, catheter 30 and endoscope502/150 are the same as described previously. In addition, it is to beunderstood that the re-insertion tool 800 and the catheter 30 aredesigned to be used in conjunction with a guide wire 36 (not shown) asdescribed previously.

As described hereinabove, C-channel 43 has an opening or slot that isslightly larger than a slit and slightly smaller than the correspondingopening of the U-channel 42. The C-channel 43 has the advantage ofcontaining the guide wire 36 therein while permitting easy passage ofthe guide wire 36 therethrough, because the opening or slot is sized tobe approximately equal to or less than the outside diameter of the guidewire 36. However, although the C-channel 43 provides these advantages,problems may arise when the catheter 30 is backloaded over the guidewire 36. Depending on the size of the port of the endoscope, the guidewire 36 may not automatically re-enter in to the C-channel 43.

Specifically, because the endoscope 502/150 may be too small toaccommodate the guide wire 36 and the catheter 30 side-by-side withinthe lumen of the endoscope, it is desirable to re-introduce the guidewire 36 into the C-channel 43 of the catheter 30 proximal of the port504 of the endoscope 502/150. Thus, with the distal portion of the guidewire 36 disposed in the C-channel 43 of the catheter 30 distal of theport 504 of the endoscope 502/150, and the proximal portion of the guidewire 36 disposed adjacent to (i.e., side-by-side) the catheter 30proximal of the port 504, the re-insertion tool 800 may be used tore-introduce the guide wire 36 into the C-channel 43 of the catheter 30proximal of the port 504. By re-inserting the guide wire 36 into theC-channel 43 of the catheter 30 proximal of the port 504, there-insertion tool 800 facilitates easy retraction and advancement of thecatheter 30 and/or guide wire 36 relative to the endoscope 502/150. There-insertion tool 800 further facilitates easy advancement andretraction of the catheter 30 independent of the guide wire 36. Furtheryet, the re-introduction tool 800 allows the use of catheter 30 withvirtually any size endoscope 502/150.

Re-insertion tool 800 includes a series of proximal flanges 804 that aresized to be slightly larger than the inside diameter of the port 504 ofthe endoscope 502/150. By providing a plurality of flanges 804, there-insertion tool 800 in sized to snugly fit in several differentendoscopes having ports 504 with different inside diameters. The flanges804 are large enough to prevent the re-insertion tool 800 frompenetrating the valve or grommet disposed in the port 504 of theendoscope 502/150, thereby preventing the re-insertion tool 800 fromfalling into the endoscope lumen.

Re-insertion tool 800 further includes a ring portion 806 disposeddistal of the flanges 804. The ring portion 806 is sized to fit insidethe port 504 of the endoscope 502/150. The ring portion 806 may have aplurality of depressions or slots 808 to impart radial flexibilitytherein.

The ring portion 806 defines an inside lumen 810 into which the shaft 38of the catheter 30 may be slidably disposed. A keel 812 is disposed inthe lumen 810 and is preferably integrally formed with the ring portion806. The keel 812 rides in the C-channel 43 of the catheter shaft 38.The keel serves to facilitate tracking of the re-insertion tool 800along the shaft 38 of the catheter 30 and prevent the re-insertion tool800 from completely sliding off the catheter 30.

The inner lumen 810 of the re-insertion tool 800 may be tapered to alarger diameter at the proximal end thereof to form a funnel shape toallow additional freedom of movement of the guide wire 36 proximal ofthe tool 800. In addition, the keel 812 may be tapered such that theproximal portion thereof is shorter than the distal portion thereof,which may serve to gradually push the guide wire 36 into the C-channel43 of the shaft 38. Re-insertion tool 800 may further include a window814 to facilitate greater freedom of movement of the guide wire 36proximal of the re-insertion tool 800.

The re-insertion tool 800 may be made of any suitable medical gradematerial and may be formed by a number of different processes. Forexample, the re-insertion tool 800 may be formed by injection molding apolymer sold under the tradename ACETAL. The preferred dimensions of there-insertion tool 800 are illustrated in FIGS. 20B-20G.

In use, as the catheter 30 is inserted into the port 504 of theendoscope 502/150, the re-insertion tool 800 may be slid down the shaft38 until it engages the valve or grommet disposed in the port 504. Afterthe guide wire 36 has been inserted into the catheter 30, the catheter30 and the guide wire 36 may be separated proximal of the port 504 toallow for faster and easier manipulation of the catheter 30 and theguide wire 36. As the catheter 30 and/or guide wire 36 are advanced intothe endoscope 502/150, the reinsertion tool 800 forces the guide wire 36back into the C-channel 43 of the catheter shaft 38. Thus, distal of there-insertion tool 800 and distal of the port 504, the guide wire 36 isconstrained inside the C-channel 43. The re-insertion tool 800 alsoconstrains the guide wire adjacent the valve or grommet disposed in theport 504, thereby protecting the guide wire 36 and catheter 30 andfacilitating free longitudinal movement thereof relative to the valve orgrommet disposed in the port 504.

Refer now to FIG. 21, which illustrates re-insertion tool 900 inaccordance with a second embodiment of the present invention. Except asdescribed herein, re-insertion tool 900 is the same in form and functionas re-insertion tool 800 described with reference to FIG. 19. A notabledifference is that re-insertion tool 900 is a twist-on device that maybe added or removed from the shaft 38 of the catheter 30 at any timeduring the procedure. Similar to the illustration of FIG. 19,re-insertion tool 900 illustrated in FIG. 21 is shown from a distalperspective, with the endoscope in the direction of arrow 902.

Re-insertion tool 900 includes a disk portion 904 having an outsidediameter sized to be larger than the inside diameter of the port 504 ofthe endoscope 502/150. Disk portion 904 serves similar functions asflanges 804 described with reference to re-insertion tool 800. Althoughnot shown, re-insertion tool 900 may include a ring portion disposed onthe distal surface of the disk portion 904 to serve the same function asring portion 806 described with reference to re-insertion tool 800.Re-insertion tool 900 further includes a keel 912 serving the samefunction as keel 812 described with reference to re-insertion tool 800.

As best seen in FIG. 22A, re-insertion tool 900 includes a lumen 910that is similarly dimensioned and serves the same function as lumen 810described with reference to re-insertion tool 800. For purposes ofillustration only, the shaft 38 of the catheter is shown in phantom inFIG. 22A. Re-insertion tool 900 further includes a window or slot 906arranged perpendicular to the lumen 910. Preferably, the window 906 hasan angular opening of 45 degrees. The slot or window 906 allows there-insertion tool 900 to be loaded from the side onto the shaft 38 ofthe catheter 30. Once the shaft 38 is disposed in the lumen 910 with thekeel 912 aligned with the C-channel 43, the re-insertion tool 900 may belocked in place by rotating the tool 900 90 degrees. Other than the sideloading and locking feature of re-insertion tool 900, the use ofre-insertion tool 900 is the same as the use of re-insertion tool 800.

A further embodiment, although not illustrated, of a re-insertion toolis contemplated comprising a “T” shaped device that is attached to andpenetrates the valve or grommet in the port 504 of the endoscope 502/150and allows a catheter 30 and guide wire 36 system to pass through arestrictive lumen disposed in the device. The restrictive lumen wouldallow just enough space for the catheter 30 to pass therethrough suchthat as the catheter 30 and the guide wire 36 are pushed through therestrictive lumen simultaneously, the guide wire 36 is forced into theC-channel 43 of the catheter 30 substantially the same as describeabove. The “T” shaped device may also have a slot running parallel tothe restrictive lumen. The slot may be deep and wide enough to allow theguide wire 36 to pass therethrough, thus allowing the removal of there-insertion device and/or the catheter 30 once the guide wire 36 hasbeen positioned.

It is further contemplated that any of the re-insertion tools describedherein may further include a locking mechanism. The locking mechanismmay be secured to the port 504 of the endoscope 502/150 or may besecured to the shaft 38 of the catheter 30. With either arrangement, theguide wire 36 is automatically re-introduced into the C-channel 43 ofthe shaft 38.

From the foregoing, it is apparent that new and useful insertion andre-insertion tools have been described. The insertion tools provide amethod for easily inserting a guide wire into a guide wire lumen of acatheter, particularly a rapid exchange catheter, for use in anendoscope. The re-insertion tools facilitate easy advancement of thecatheter and/or guide wire into the side port of the endoscope. Thoseskilled in the art will recognize that the present invention may bemanifested in a wide variety of forms other than the specificembodiments contemplated and described herein. Accordingly, departuresin form and detail may be made without departing from the scope andspirit of the present invention as described in the appended claims.

1. A method of inserting a guide wire into a guide wire lumen of acatheter for use in a lumen of and endoscope, comprising the steps of:providing an insertion tool comprising a main body having a main lumenextending therethough and a funnel-shaped extension having a funnellumen extending therethrough; placing the insertion tool on the cathetersuch that the catheter extends through the main lumen; and inserting theguide wire through the funnel of the insertion tool and into the guidewire lumen of the catheter.
 2. A method of inserting a guide wire as inclaim 1, wherein the insertion tool includes a distal merged section,further comprising the steps of: prior to inserting the guide wire,advancing the insertion tool along the catheter; and inserting a portionof the merged section into the lumen of the endoscope.
 3. A method ofinserting a guide wire as in claim 2, wherein the merged section isinserted into the lumen of the endoscope a sufficient distance to open avalve disposed therein, thereby permitting unhindered longitudinalmovement of the catheter therethough.
 4. A method of inserting a guidewire as in claim 3, further comprising the step of sliding the insertiontool proximally along the catheter, thereby removing the merged sectionfrom the lumen of the endoscope while the guide wire remains disposed inthe guide wire lumen of the catheter.
 5. A method of inserting a guidewire as in claim 1, further comprising the steps of: prior to insertingthe guide wire, advancing the insertion tool along the catheter; andinserting a portion of the main body into the lumen of the endoscope. 6.A method of inserting a guide wire as in claim 5, the main body isinserted into the main body is inserted into the lumen of the endoscopea sufficient distance to open a valve disposed therein, therebypermitting unhindered longitudinal movement of the cathetertherethrough.
 7. A method of inserting a guide wire as in claim 6,wherein the insertion tool includes a longitudinal slot in the mainbody, further comprising the step of removing the guide wire from theinsertion tool through the slot while the guide wire remains disposed inthe guide wire lumen of the catheter.
 8. A method of inserting a guidewire as in claim 1, wherein the insertion tool includes a longitudinalslot, further comprising the step of removing the guide wire from theinsertion tool through the slot while the guide wire remains disposed inthe guide wire lumen of the catheter.
 9. A method of inserting a guidewire as in claim 1, wherein the insertion tool is adapted to allow theguide wire to be moved laterally out of the main body, wherein themethod further comprised, with the catheter inserted at least partiallyinto the endoscope and the guidewire at least partially inserted intothe catheter such that a portion of the guidewire is inside theendoscope, the following steps: moving the guide wire laterally out ofthe insertion tool; and removing the catheter from the endoscope whileholding the guide wire in place such that, after the catheter is removedfrom the endoscope, the guide wire remains at least partially inside theendoscope.
 10. The method of claim 9, further comprising: inserting asecond catheter over the guidewire into the endoscope.
 11. The method ofclaim 1, further comprising: providing an alignment mechanism adjacentto the main lumen that is adapted to engage the catheter when thecatheter is inserted in the main lumen, the alignment adapted to createa particular relative radial alignment of the catheter with respect tothe insertion tool, wherein, when the catheter is in the particularrelative radial alignment, the funnel lumen aligns with the guide wirelumen of the catheter.
 12. The method of claim 1, further comprising:providing alignment means on the insertion tool for engaging thecatheter when the catheter is inserted in the main lumen, the alignmentmeans adapted to cause the catheter to assume a particular relativeradial alignment with respect to the insertion tool when the catheter isinserted in the main lumen, wherein, when the catheter is in theparticular relative radial alignment, the funnel lumen aligns with theguide wire lumen to the catheter.
 13. A method of inserting a guide wireinto a guide wire lumen of a catheter comprising the steps of: providingan insertion tool having a main lumen sized to receive the catheter anda secondary lumen which intersects the main lumen, the secondary lumenhaving a first end and a second end, the secondary lumen having agreater cross sectional area at the first end than at the second end,wherein the second end of the secondary lumen intersects the main lumen;providing an alignment mechanism adjacent to the main lumen that isadapted to engage the catheter when the catheter is inserted in the mainlumen, the alignment mechanism adapted to create a particular relativeradial alignment of the catheter with respect to the insertion tool,wherein, when the catheter is in the particular relative radialalignment the second end of the secondary lumen is adjacent the guidewire lumen of the catheter; placing the insertion tool such that acatheter is received in the main lumen; and inserting the guide wirethrough the secondary lumen and into the guide wire lumen of thecatheter.
 14. A method of manipulating a guide wire comprising:providing a guide wire insertion tool, the insertion tool having areceiving location for receiving the guide wire and a feeding locationfor feeding the guide wire into a guide wire lumen of a catheter;providing a guide wire locking tool adapted to couple to the catheterand having a locking receiver at which a guide wire may be laterallyinserted and axially secured; placing the guide wire insertion toolrelative to the catheter such that the feeding location is in a placeallowing the guide wire to be fed into the guide wire lumen; insertingthe guide wire at the receiving location, through the guide wireinsertion tool, out of the feeding location and into the guide wirelumen; and securing the guide wire at a fixed axial location withrespect to the catheter using the guide wire locking tool.
 15. Themethod of claim 14, wherein the guide wire insertion tool includes afunnel shaped lumen extending from the receiving location to the feedinglocation, wherein the funnel shaped lumen has a larger cross-sectionalarea at the receiving location than at the feeding location.
 16. Themethod of claim 15, wherein the guide wire insertion tool includes amain lumen sized to receive the catheter.
 17. The method of claim 14,wherein the guide wire insertion tool is adapted to allow a guide wireinserted into the receiving location and exiting from the feedinglocation to be moved laterally out of the guide wire insertion tool. 18.The method of claim 17, further comprising the steps of: after securingthe guide wire at a fixed axial location with respect to the catheter,performing the following steps: releasing the guide wire from the fixedaxial location; moving the guide wire laterally out of the guide wireinsertion tool; and while maintaining the guide wire at a fixedlocation, moving the catheter.
 19. The method of claim 18, wherein themethod is applied to place a guide wire in a guide wire lumen of acatheter which has been inserted into an endoscope, and wherein the stepof moving the catheter includes removing the catheter from the endoscopeand leaving the guide wire extending into the endoscope.
 20. The methodof claim 19, wherein the guide wire has a proximal end and a distal endand the endoscope has a proximal end and a distal end, wherein thedistal end of the endoscope is inserted to a patient, and wherein, aftermoving the catheter, the catheter is disengaged from the endoscope andthe guide wire, the method further comprising: selecting a secondcatheter having a proximal end, a distal end and a guide wire lumen;placing the proximal end of the guide wire into the guide wire lumen ofthe second catheter near the distal end of the second catheter; andinserting the second catheter into the endoscope over the guide wire.